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The Case Files: Ingestion of Zinc Phosphide

Dr. Sanaei-Zadeh is an associate professor of forensic medicine and clinical toxicology at Shiraz University of Medical Sciences in Shiraz, Iran. He completed a fellowship in critical care toxicology at the Dhanvantri Critical Care Center in Erode, Tamil Nadu, India.

An 18-year-old man presented one hour after the suicidal ingestion of approximately 10 g of steel-gray crystalline powder of zinc phosphide (Zn3P2) dissolved in fruit juice, after which he immediately vomited. He was conscious and had no chief complaint, but he presented to the emergency department because he feared death.

All lab tests (CPK, LDH, and liver function tests in addition to repeats of the lab tests done at presentation) were within normal limits. MgSO4 was discontinued after 24 hours, and N-acetyl cysteine was initiated. Premature atrial contractions and PVCs were still present. An echocardiogram was performed, and his ejection fraction was reported to be 55% and the valves were normal. (See figure 3.)

His lab results were normal except for hypomagnesemia. Magnesium sulfate was again initiated. A day later, calcium gluconate, NAC, and MgSO4 were discontinued. He was transferred to the toxicology ward after three days in the ICU, and he was discharged two days later with PVCs and sinus arrhythmias in a good physical condition.

Zinc phosphide is similar to aluminum phosphide in releasing phosphine (PH3) when coming in contact with moisture. (Public Health Rep 1947;203:1.) PH3 is absorbed from the gastrointestinal tract, and it disturbs the mitochondrial function by blockage of the cytochrome C oxidase once it reaches the tissues. Energy failure in cells and generation of the free radicals also result in lipid peroxidation. (Vet Hum Toxicol 1989;31[6]:559.) Previous studies have shown that almost 25 percent of the patients who refer after zinc phosphide ingestion are asymptomatic and 33 percent are metabolically stable. (J Adv Res 2011;2[2]:149; J Pak Med Assoc 2008;58[5]:289; Egypt J Ind Med 1984;8:211; Int J Clin Pharmacol Ther 1998;36[7]:406.)